esophageal stenosis
Introduction
Introduction Generally refers to benign esophageal diseases (without tumors) or complications leading to esophageal stenosis. Benign and congenital causes of benign esophageal stricture. The former is extremely rare, mostly for a limited thickening of the esophagus, or a ring-shaped, valvular septum in the esophageal mucosa; the latter is most common with scarring stenosis. Common causes of acquired stenosis: esophageal mucosa epithelium due to inflammatory damage or chemical corrosion, scar formation after repair; esophageal tumors such as esophageal cancer block esophageal lumen to varying degrees; esophageal tissue lesions caused by external compression of the esophagus, such as lung and Mediastinal tumor, aneurysm, goiter and so on. Common causes of scarring stenosis: 1 injurious esophageal stricture; 2 esophagitis (digestive reflux) caused by stenosis; 3 surgery is very expensive after esophageal stricture.
Cause
Cause
1 Injurious esophageal stricture:
The most common cause is a chemical corrosive injury caused by a swallowing etchant (a strong base or a strong acid), which results in a scarring stenosis. In addition, esophageal foreign bodies (dentures, sharp bones) or iatrogenic (instrumental examination or treatment, radiation exposure treatment) damage is rare, but it also occurs.
During the process of swallowing, the corrosive agent causes different distributions of different depths and depths in the mouth, pharynx, esophagus and stomach, but the pathological changes are closely related to factors such as the concentration of the corrosive agent, the dose, and the length of time to stay in contact with the esophagus. The degree of burn can be from the esophageal mucosa congestion and edema, epithelial shedding until deep into the muscular layer, ulceration and even involving the entire esophagus, resulting in perforation. The scar formation period begins about 3 weeks after injury and gradually increases, reaching the most severe stage after several weeks to several months.
Generally, the stenosis is no longer stable after 6 months of injury. The range of traumatic scar stenosis is segmental, and some have a wide range of esophageal length. The esophageal tissue in the stenosis loses its normal layered structure and is replaced by thickened fibrous tissue called a scarred hard tube. The lumen is highly narrow, with varying degrees of dilatation and thickening of the wall in the stenotic end of the esophagus. Especially in the stenosis after the corrosive agent burns, the esophagus adheres tightly to the surrounding tissue due to the chronic inflammatory reaction, and the surgical separation is difficult. Esophageal scars caused by esophageal foreign body or iatrogenic injury are mostly limited to a certain segment and the condition is mild. Stenosis lesions can be complicated by cancer after a long period of time, should be vigilant, if necessary, endoscopic brush and biopsy to rule out malignant transformation.
2 esophagitis (digestive, reflux) causes stenosis:
The esophageal mucosa is often stimulated by acid and bile reflux, which can cause mucosal ulcers, inflammation, and even granulation, scarring, and contraction.
The formation of reflux esophagitis is determined by two factors:
1 The frequency and amount of gastric juice and pancreatic juice flow back into the esophagus;
2 The activity of the esophagus is reduced, and the function of refluxing without emptying and preventing long-term contact with the mucosa is low. This disease often coexists with hiatal hernia, or the physiological function of the sphincter is destroyed after cardia surgery (such as cardia or esophagogastric anastomosis). The stenosis occurs mostly in the lower part of the esophagus, but can extend upwards;
3 esophageal stricture after surgery.
Different types of stenosis can occur in the esophageal surgical site. Some are characterized by suture reaction or anastomosis technique, resulting in a large amount of granulation tissue in the anastomosis, and contraction after fibrosis; some are caused by chronic inflammation or postoperative reflux esophagitis during esophageal surgery.
Examine
an examination
Related inspection
Esophageal pressure measurement esophagography
1 injurious esophageal stricture
X-ray esophageal barium meal examination can show the location, extent and length of the stenosis. The stenosis caused by the burning of chemical corrosive agents generally presents long narrow stenosis with irregular edges and uneven lumen. Other causes are more limited, segmental or annular stenosis. Highly narrow cases often do not understand the full extent of the stenosis and the distal esophageal condition. In addition to understanding the location and extent of the stenosis, esophagoscopy can also rule out malignant changes, but most of them can not understand the distal situation through stenosis.
2 esophagitis (digestive, reflux) caused by stenosis
X-ray swallowing examination can observe the location of the stenosis, the length, the dynamic state of the esophageal wall, and the use of body position to see reflux. Esophagoscopy can confirm the presence or absence of esophagitis, ulcers, stenosis and the elimination of malignant transformation. Esophageal function tests, including esophageal manometry, acid reflux test, acid clearance test, and 24-hour intra-abdominal pH monitoring are helpful in determining the diagnosis, analyzing the severity, and determining the presence or absence of surgical indications.
3 esophageal stricture after surgery.
Similar to 2 esophagitis (reflux, digestive) esophageal stenosis.
Diagnosis
Differential diagnosis
1. Esophageal tuberculosis: relatively rare, generally secondary, such as proliferative lesions or tuberculoma, can lead to varying degrees of obstruction, difficulty swallowing or pain. The progress of the disease is slow, and there are more young and middle-aged patients, and the average age of onset is less than that of esophageal cancer. There is often a history of tuberculosis, OT test is positive, there are symptoms of tuberculosis, endoscopic biopsy helps identify. There are three manifestations of esophageal angiography: 1 filling defect and ulcer in the esophagus, the lumen of the lesion is slightly narrow, the wall of the tube is slightly stiff, the shadow is large and obvious, the edge of the shadow is not complete, and the surrounding filling defect is not obvious. 2 The side wall of the esophagus is filled with defects, and the mass formed by the mediastinal lymph node tuberculosis around the esophagus oppresses the esophageal cavity and invades the esophageal wall. 3 esophageal fistula formation. It is characterized by a small protruding shadow of the esophageal wall, like a small shadow, with no filling defects around it. For mediastinal lymph node tuberculosis, complicated with lymph node esophageal fistula. Finally, the diagnosis is determined by esophageal cytology or esophagoscopy.
2. Esophagitis: esophageal hiatus hernia complicated with reflux esophagitis, similar to early stinging or burning pain of esophageal cancer, X-ray examination of the mucosal texture is rough, the lower esophageal lumen is slightly narrow, there is an expectorant retention phenomenon, part Mucosal shadows can be seen in the case. For cases that are not easily confirmed, esophageal cytology or esophagoscopy should be performed.
Iron deficiency pseudo esophagitis: This disease is more common in women, in addition to difficulty in swallowing, there are small cell hypochromic anemia, glossitis, gastric acid deficiency and anti-A. After iron treatment, the symptoms improved quickly.
3. Benign esophageal stricture: a history of acid and alkali chemical burns, X-ray can be seen esophageal stricture, mucosal wrinkles disappear, the wall is stiff, and the stenosis and the normal esophageal segment gradually transition. Clinically, be wary of the possibility of cancer on the basis of long-term inflammation.
